Citation: [SA] v. Security National Insurance Company, 2025 ONLAT 25-003171/AABS - A

Licence Appeal Tribunal File Number: 25-003171/AABS

In the matter of an application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8, in relation to statutory accident benefits.

Between:

[SA]

(A minor by litigation guardian [RJ])

Applicant

and

Security National Insurance Company

Respondent

AMENDED DECISION

ADJUDICATOR:

Dagmara Szczudlo

APPEARANCES:

For the Applicant:

Baldeep Virk, Counsel

Troy Hawkings Hawkins, Articling Student

For the Respondent:

Anju Sharma, Counsel

Court Reporter:

Jo Velimirovic

HEARD by videoconference:

December 2, 2025

OVERVIEW

1[SA], the applicant, was involved in an automobile accident on November 30, 2023, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). The applicant was denied benefits by the respondent, Security National Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

ISSUES

2The issues in dispute are:

i. Is the applicant entitled to $3,503.74 for visitor travel and meal expenses, on a claim form (OCF-6) submitted April 4, 2024?

ii. Is the applicant entitled to $10,040.06 ($13,237.84 less $3,197.78 approved) for visitor travel and meal expenses, on a claim form (OCF-6) submitted April 4, 2024?

iii. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?

iv. Is the applicant entitled to interest on any overdue payment of benefits?

RESULT

3The applicant is entitled to $2,776.38 for Uber Eats and Uber transportation in relation to the OCF-6 for $3,503.74.

4Paragraph [42] below provides a list of reasonable and necessary expenses based on the address where the expense was incurred. I direct the parties to utilize the addresses provided to re-review meal and transportation receipts which have not already been approved to calculate the additional payment to which the applicant is entitled to in relation to the partially approved OCF-6 for $10,040.06 ($13,237.84 less $3,197.78 approved).

5The applicant is not entitled to an award under s. 10 of Regulation 664.

6Interest is payable on any overdue amounts in accordance with s. 51 of the Schedule.

PROCEDURAL ISSUE

Motion to exclude amended applicant’s document brief granted

7At the onset of the hearing, I partially granted the respondent’s written motion request.

8On December 1, 2025, the respondent filed a written motion to exclude specific pages of the applicant’s combined evidence and authority brief served on November 11, 2025 (767-page brief). The pages to be excluded contained summaries of receipts drafted by counsel, Google Earth images corresponding to specific addresses, and additional receipts. The respondent submitted that the applicant’s counsel created evidence which cannot be tested by way of cross-examination by preparing the summary charts. The respondent also requested that an amended hearing brief served by the applicant on November 24, 2025 (831-page brief) should be excluded because it was not filed in accordance with Rules 9.3, 9.4.2 and 9.4.3 of the Licence Appeal Tribunal Rules, 2023 (“the Rules”).

9Upon receipt, the Tribunal advised the parties that the Motion would be heard the next day at the hearing.

10The applicant opposed the written motion and submitted that it is customary for the Tribunal to accept charts and summaries. The applicant argued that the charts will be presented to the applicant’s litigation guardian during the hearing and cross-examination of this witness will be feasible. In relation to the late filing, the applicant submitted that the CCRO required a detailed summary of all payments made to the applicant or paid directly to suppliers for visitor’s expenses and meals, however, the respondent did not comply with the order. Instead, the applicant was forced to generate the chart summaries to provide a breakdown of expenses by delivery address to streamline the hearing.

11The applicant further submitted that the amended hearing brief should be admitted because it is more accurate and easier to follow. The page difference was attributed to triplication of the special award submissions and duplication of certain receipts.

12Having considered the factors outlined in Rule 9.3 of the Rules, I partially granted the respondent’s request and excluded the amended hearing brief served by the applicant on November 24, 2025 (831-page brief) because it was served and filed less than 21 days before the videoconference hearing and additional time would be required to confirm that the page difference is in fact the result of repetition of existing information.

13In relation to receipt summaries and Google Earth images contained in the applicant’s original hearing brief, I find that these materials were submitted in accordance with the CCRO and there was no failure to comply with Rule 9.3. I find that the summary charts and Google Earth images are demonstrative aids based on documents which were previously shared with the respondent. They are relevant and the respondent is not prejudiced by their inclusion because their substance was already known and can be subject to cross-examination. I find the summaries useful in navigating a large volume of receipts in dispute and gaining a ‘big picture’ view for the categories of expenses which were submitted. As a result, the respondent’s motion in relation to these materials was denied and the materials were admitted as exhibits for the hearing.

The Law

14Section 22(1) of the Schedule provides that if the applicant sustains an impairment as a result of an accident, the respondent shall pay for reasonable and necessary expenses incurred not more than 104 weeks after the accident by the following persons as a result of the accident in visiting the applicant during his treatment or recovery: the spouse, children, grandchildren, parents, grandparents, as well as brothers and sisters of the applicant. As per section 22(2), the time limit of 104 weeks does not apply if the applicant sustained a catastrophic impairment because of the accident.

15The applicant seeks payment for two OCF-6s in the amount of $3,503.74 and $10,040.06 ($13,237.84 less $3,197.78 approved) which consists of meal and local transportation expenses incurred by his parents and siblings.

16The applicant bears the onus to prove that submitted visitor expenses are reasonable and necessary under section 22(1) subject to a standard of proof on a balance of probabilities.

ANALYSIS

Background

17At age 10, the applicant was involved in an automobile accident. He was an unrestrained passenger in a vehicle which was involved in a high-speed collision. He suffered a traumatic brain injury and was treated at [a hospital] (November 30 to December 11, 2023) and [a Rehabilitation Centre] (December 11, 2023 to February 6, 2024). The respondent designated the applicant as catastrophically impaired shortly after the accident. This catastrophic determination entitles the applicant to additional medical, rehabilitation, attendant care benefits, and case manager services as per s. 17 of the Schedule. The applicant is also entitled to visitor expenses as per s. 22 of the Schedule.

18The following visitor expenses OCF-6s were submitted:

Table 1. Summary of visitor expenses submitted.

Date OCF-6 submitted	Time period covered	Amount Submitted	Amount Approved	Amount Denied	Notes
January 2, 2024	November 30, 2023 to December 28, 2023	$3,608.30	$3,608.30	$0	Fully reimbursed January 12, 2024 as stated in TD Insurance letter dated April 26, 2024.
April 4, 2024	December 11, 2023 to January 4, 2024	$3,503.74	$0	$3,503.74	TD Insurance letter dated April 26, 2024 – receipts not legible and request for more information.
April 4, 2024	December 2, 2023 to February 8, 2024	$13, 237.84	$3,197.78	$10,040.06	TD Insurance letter dated May 9, 2024 – certain expenses not reasonable and necessary or were previously submitted and reimbursed already.

Applicant’s Submissions and Evidence

19The applicant submits that expenses were incurred while the applicant’s parents and siblings were visiting the applicant in hospital from November 30, 2023 to February 8, 2024. In addition, some expenses were incurred to deliver food to the applicant’s siblings at their home in [a city], Ontario while their mother was at the hospital with their brother.

20The applicant submits that s. 22 of the Schedule does not require food to be incurred while visiting in the hospital, nor by people that are at the hospital. She argues that the expenses were reasonable and necessary because the family did not have a car during this time and was caring for two other young children while the applicant was hospitalized. Visiting the applicant required taxis, Uber ride shares, and quick meals delivered to various locations and there were no alternatives that could have been considered at the time.

21The applicant relies on the testimony of [RJ], Mother/Litigation Guardian, who testified that her son was severely injured in the accident and needed to re-learn how to eat, talk, and walk. [RJ] stated that the family resides in [a city] in Ontario and stayed in hotels near [a hospital] and [a Rehabilitation Centre] while the applicant was hospitalized and did not have a car after the accident. She relied on food delivery services and purchases of prepared meals and snacks from Whole Foods and Shoppers Drug Mart to save time and to be present with her son at the hospital.

22The applicant also argues that the first OCF-6 submitted was fully approved by the respondent and subsequent receipts were submitted in the same manner, but were denied and partially approved. The family was not asked to keep an itemized list of expenses outlining who incurred the expense and instead the respondent relied on s. 33 to ask for further particulars and used boilerplate reasons such as that the receipts were not legible to deny payment. The applicant argues that Uber Eats and Uber receipts provide information necessary to assess the expense, including the account holder (applicant’s mother), the pickup and drop off addresses, as well as the payment method used. The applicant submits that legible receipts and clarifying information were provided in response to the respondent’s request as of April 5, 2024 but were not actioned.

Respondent’s Submissions and Evidence

23The respondent submits that the applicant was deemed to be catastrophically injured immediately after the accident, and his claim was adjusted in good faith. The first OCF-6 for visitor expenses was approved in the acute phase of the injury without requests for further information, however, this does not prevent the respondent from asking for particulars associated with subsequent OCF-6s, nor scrutinizing those expenses to determine whether they were reasonable and necessary.

24The initial OCF-6 was for nominal expenses from the hospital and some Uber rides, but subsequent expenses show a pattern of more frequent and extravagant purchases from different sources, some within minutes of each other and were categorized in three main groups: Uber travel receipts, grocery receipts, and Uber Eats receipts.

25The respondent submitted that not all Uber travel receipts were for trips to the hospitals to visit the applicant. Instead, they included trips to [a city], limousine expenses for a ride to the Scotiabank Arena (formerly the Air Canada Center, “ACC”)), and travel to other addresses. The respondent argues that no further Uber or transportation expenses are payable because the applicant did not meet their onus to prove that they are reasonable and necessary visitor expenses.

26In relation to grocery receipts, the respondent submitted that the applicant’s family would be required to purchase groceries regardless of whether the applicant was in the hospital or not. The respondent argued that the family submitted grocery receipts for periods when the applicant was at home on a weekend pass from the rehabilitation hospital and these expenses cannot be classified as visitor expenses. Receipts submitted for grocery delivery to temporary accommodation in the vicinity of the hospitals, to the applicant’s home in [a city], and Shoppers Drug Mart receipts for personal care products are not payable because they are regular expenses not visitor expenses.

27In relation to Uber Eats receipts, the respondent submitted that the applicant’s parents would be required to take care of their remaining children regardless of whether the applicant was in the hospital or not. The respondent argued that food expenses were incurred in Toronto and in [a city] the same day, sometimes within the same hour without explanation and food delivery to save time is not contemplated by s. 22. The fact that the mother was expected to cook for her family because she did not work outside the home, is not a valid reason to grant the family freedom to order meals when the mother is visiting the applicant and is not available to prepare meals for remaining family members.

OCF-6 for $3,503.74 for visitor travel and meal expenses

28The applicant is entitled to $2,776.38 for Uber Eats and Uber transportation in relation to the OCF-6 for $3,503.74.

29The applicant seeks payment for visitor expenses in the amount of $3,503.74 which consists of meal and local transportation expenses incurred between December 11, 2023 to January 4, 2024 as follows:

i. $1,398.20 for Uber Eats

ii. $2,105.54 for Uber transportation

30The applicant submitted that Uber Eats and Uber transportation receipts covered by this OCF-6 relate to meal deliveries and rides to the following addresses:

i. Toronto, Address of [a Rehabilitation Centre);

ii. Address of [a hotel], temporary accommodation while the applicant was at [a Rehabilitation Centre];

iii. Family residence in [a city];

iv. Applicant’s grandparents’ residence in [a city]; and

v. Whole Foods Market, located in the vicinity of [a Rehabilitation Centre].

31I note that the applicant’s family lives in the immediate vicinity of the applicant’s grandparents (300 meters away) and may walk between the residences in several minutes.

32I find that receipts and sufficient evidence was provided by the applicant to determine that Uber Eats meal delivery expenses to the following addresses are reasonable and necessary because they correspond to locations where the applicant was receiving rehabilitation and temporary accommodation for the family while the applicant was at [a Rehabilitation Centre].

i. Toronto, Address of [a Rehabilitation Centre); and

ii. Address of [a hotel], temporary accommodation while the applicant was at [a Rehabilitation Centre].

33I also find that although receipts were provided for meal delivery to the applicant’s family residence and his grandparent’s residence, these expenses are not reasonable and necessary because they cover meals ordered for the applicant’s sibling(s), who were not visiting their brother at the rehabilitation hospital nor staying at the temporary accommodation near this hospital at the time the expenses were incurred.

34I agree that there is collateral impact on the relatives of the insured person because of the accident, particularly when the mother of three young children is unable to prepare meals for her family because she is visiting a severely injured child. However, I note that the applicant’s family lives in the immediate vicinity of the applicant’s grandparents because food was also delivered to the grandparent’s residence. I find that s. 22 provides coverage for visitor expenses and does not extend to meal expenses for the visitor’s dependants while they are in the care of their grandparents or other childcare providers. As a result, meal deliveries to the applicant’s family residence and his grandparent’s residence in [a city] are not payable by the respondent. The applicant did not provide any binding authority to support a determination otherwise.

35I accept the applicant’s detailed break-down of Uber Eats deliveries to, Toronto and North York, presented in the hearing brief and find that $1,030.09 for Uber Eats deliveries to these addresses are payable in relation to the OCF-6 for $3,503.74.

36I will now turn to Uber transportation expenses.

37In terms of Uber transportation expenses, I find that that receipts and sufficient evidence was provided by the applicant to determine that transportation expenses to and/or from [a city] to the following addresses are reasonable and necessary because they correspond to locations where the applicant was receiving rehabilitation and temporary accommodation while the applicant was at [a Rehabilitation Centre].

i. Toronto, Address of [a Rehabilitation Centre); and

ii. Address of [a hotel], temporary accommodation while the applicant was at [a Rehabilitation Centre].

38Transportation expenses between [a hotel] and the rehabilitation hospital are also payable by the respondent. I accept that the family did not have a car during this time and needed to travel between [a city] and Toronto/North York to visit their son and maintain contact with other members of the family.

39I find that transportation receipts listing an origin or destination different than the applicant’s home address, the grandparent’s home address or an address other than those listed above not reasonable and necessary because they are not directly associated with visiting the applicant. Specifically, I find that Uber transportation receipts to Whole Foods and Toronto, are not payable, also noting that these locations are within a reasonable walking distance to the rehabilitation hospital.

40I accept the applicant’s detailed break-down of Uber transportation receipts to/from [a city] and/or Toronto and/or North York presented in the hearing brief and find that $1,746.29 ($1,754.47 less $8.18 for transportation to Toronto denied) to be payable in relation to the OCF-6 for $3,503.74.

41In total, the applicant is entitled to $2,776.38 for Uber Eats and Uber transportation in relation to the OCF-6 for $3,503.74.

OCF-6 for $13,237.84 for visitor travel and meal expenses (partially approved for $3,197.78 leaving $10,040.06 in dispute)

42Since partial approval was already provided in relation to this OCF-6, I find, in keeping with my reasons below, that the applicant:

i. Is entitled to meal expenses at, and Uber Eats delivery to, the following addresses: [an address] in Toronto; [a second address] in Toronto; [a third address] in Toronto; and [a fourth address] in Toronto;

ii. Is not entitled to the expenses itemized in Uber Eats receipts dated January 10, 2024 for $151.23 (Applicant’s brief pg. 547 of 767); and January 12, 2024 for $123.01 ($112.07 + $10.94, Applicant’s brief pg. 534 of 767);

iii. Is entitled to reimbursement of expenses supported by receipts from Whole Foods Market;

iv. Is not entitled to reimbursement of expenses supported by receipts from Shoppers Drug Mart;

v. Is not entitled to reimbursement of meal delivery to the applicant’s family residence and his grandparent’s residence;

vi. Is entitled to reimbursement of transportation expenses to and/or from [a city] to the following addresses: [an address] in Toronto; [a second address] in Toronto; [a third address] in Toronto; and [a fourth address] in Toronto;

vii. Is not entitled to payment for transportation receipts listing an origin or destination different than the applicant’s home address, the grandparent’s home address or an address other than those listed in (vi) above;

viii. Is not entitled to payment of limousine transportation expenses to the ACC in the amount of $105.00 incurred on January 24, 2024; and

ix. Is not entitled to payment of $3,720.78 for hotel/accommodations near hospital(s) claimed on this OCF-6.

43I direct the parties to utilize the list of addresses provided in this decision to re-review meal and transportation receipts submitted to calculate the additional payment to which the applicant is entitled.

44Specifically, the applicant seeks payment for visitor expenses in the amount of $13,237.84 which consists of meal, accommodation, and local transportation expenses incurred between December 2, 2023 to February 8, 2024 as follows:

i. $2,352.18 for Uber transportation

ii. $3,667.35 for Uber Eats

iii. $1,523.45 for food purchased at hospital(s)

iv. $3,720.78 for hotel/accommodations near hospital(s)

v. $450.63 for taxis

45The applicant submitted that receipts covered by this OCF-6 relate to meal deliveries and rides to the following addresses:

i. Toronto, address of [a Rehabilitation Centre];

ii. Toronto Address of [a hotel], temporary accommodation while the applicant was at [a Rehabilitation Centre].

iii. Toronto [Address], temporary accommodations while applicant was at [a Rehabilitation Centre];

iv. Toronto address of [a Hospital];

v. Toronto address of [a second hospital];

vi. Toronto address (pick up point near [a second hospital])

vii. Family residence in [a city]

viii. Applicant’s grandparents’ residence in [a city]; and

ix. Whole Foods Market and Shopper’s Drug Mart, located in the vicinity of [a Rehabilitation Centre].

Meal Expenses

46With specific exceptions, I find that receipts and sufficient evidence was provided to determine that meal expenses at, and Uber Eats delivery to, the following addresses are reasonable and necessary because they correspond to locations where the applicant was receiving treatment/rehabilitation and temporary accommodation for the family near the applicant’s location:

i. Toronto, address of [a Rehabilitation Centre];

ii. Toronto Address of [a hotel], temporary accommodation while the applicant was at [a Rehabilitation Centre];

iii. Toronto [Addresses], temporary accommodations while applicant was at [a Rehabilitation Centre]; and

iv. Toronto address of [a hospital].

47The exceptions to this finding are two receipts for Uber Eats delivery to [a rehabilitation hospital] and Toronto [Address], temporary accommodations because the items purchased are groceries and personal items which I find are not meal/prepared meal visitor expenses. The respondent is not ordered to reimburse the expenses listed below:

i. Uber Eats receipt dated January 10, 2024 for $151.23 (Applicant’s brief pg. 547 of 767); and

ii. Uber Eats receipt dated January 12, 2024 for $123.01 ($112.07 + $10.94, Applicant’s brief pg. 534 of 767).

48Based on my review of receipts from Whole Foods Market in relation to this OCF-6, for a total of $725.80, I find that these receipts are for prepared meals, beverages, fruit, prepared baby food, and snacks. Although purchased from a grocery store, I disagree with the respondent’s characterization of these receipts as grocery purchases and find that they are reasonable and necessary purchases to cover visitor expenses while the applicant’s caretaker(s) and sibling(s) were staying in the vicinity of [a Rehabilitation Centre]. The applicant is entitled to reimbursement of expenses supported by receipts from Whole Foods Market in relation to this OCF-6.

49Based on my review of receipts from Shoppers Drug Mart in relation to this OCF-6, for a total of $225.86, I find that expenses detailed in these receipts are for personal care items and purchases that qualify as groceries as opposed to prepared meals for visitors. The applicant is not entitled to reimbursement of expenses supported by receipts from Shoppers Drug Mart in relation to this OCF-6.

50I also find that although receipts were provided for meal delivery to the applicant’s family residence and his grandparent’s residence, these expenses are not reasonable and necessary because they cover meals ordered for the applicant’s sibling(s) who were not visiting their brother at the rehabilitation hospital nor staying at the temporary accommodation near this hospital at the time the expenses were incurred.

51Since partial approval was already provided in relation to this OCF-6, I direct the parties to utilize the addresses provided above to review meal receipts which have not already been approved to calculate the additional payment to which the applicant is entitled, if any. It is not the role of the Tribunal to act as an accountant and to reconcile accuracy of payments, particularly considering such a large volume of receipts. I turn to transportation expenses associated with this OCF-6 next.

Transportation Expenses

52In terms of Uber and taxi transportation expenses, with specific exceptions, I find that that receipts and sufficient evidence was provided by the applicant to determine that transportation expenses to and/or from [a city] to the following addresses are reasonable and necessary because they correspond to locations where the applicant was receiving rehabilitation and temporary accommodation for the family near the applicant’s location:

i. Toronto, address of [a Rehabilitation Centre];

ii. Toronto Address of [a hotel], temporary accommodation while the applicant was at [a Rehabilitation Centre;

iii. Toronto [Addresses], temporary accommodations while applicant was at [a Rehabilitation Centre]; and;

iv. Toronto address of [a hospital].

53I find that transportation receipts listing an origin or destination different than the applicant’s home address, the grandparent’s home address or an address other than those listed above not reasonable and necessary because they are not directly associated with visiting the applicant.

54I also decline to order payment of limousine transportation expenses to the ACC in the amount of $105.00 incurred on January 24,2024. The applicant’s mother testified that her son received a pair of tickets to a game as a reward for progress from the rehabilitation hospital. The purpose of this expense was to transport the applicant from the rehabilitation hospital to the ACC. I find that more cost-effective transportation choices were available, and limousine expenses are not reasonable and necessary nor related to visitor expenses as outlined in s. 22.

55Since partial approval was already provided in relation to this OCF-6, I direct the parties to utilize the addresses provided above to review Uber and taxi transportation receipts which have not already been approved to calculate the additional payment to which the applicant is entitled, if any. It is not the role of the Tribunal to act as an accountant and to reconcile accuracy of payments, particularly considering such a large volume of receipts. I turn to hotel/accommodations expenses associated with this OCF-6 next.

Hotel/accommodation expenses near hospital(s)

56I decline to order payment for hotel/accommodation expenses near the hospitals included on this OCF-6.

57The applicant seeks payment for accommodation expenses in the amount of $3,720.78 for hotel/accommodations near hospital(s) claimed on this OCF-6.

58The respondent’s EOB dated May 9, 2024 in relation to this line item on the OCF-6 states that:

i. [Second Hotel] dated December 6 - 10, 2023 in the amount of $1,495.00 was previously paid; and

ii. [A Hotel] dated January 2-5 and 7-9, 2024 is a duplicate payment and was already previously paid.

59The applicant’s combined evidence and authority brief served on November 11, 2025 (767-page brief) does not include any hotel/accommodation receipts associated with this line item, nor provide a response to the respondent’s position that these expenses were previously paid. As a result, I decline to order payment of $3,720.78 for hotel/accommodations near hospital(s) claimed on this OCF-6.

Are the OCF-6s payable pursuant to s. 38(8)?

60The OCF-6s are not payable pursuant to s. 38(8) of the Schedule because s. 38 does not apply to the claimed expenses.

61Section 38(8) requires an insurer to inform an insured person, within 10 business days after it receives a treatment plan, of the medical and other reasons why it considered the goods and services not to be reasonable and necessary if it denies a plan. Pursuant to s. 38(11), if an insurer fails to comply with its obligations under section 38(8), it must pay for the goods and services that relate to the period starting on the 11th business day after the insurer received the application and ending on the day the insurer gives a notice described in s. 38(8) and it is prohibited from taking the position that the insured person has a impairment to which the MIG applies.

62The applicant submits that the denial letters for the OCF-6s were improper because they do not include an explanation of benefits (“EOB”), nor itemized lists of what was approved or reasons for denial in relation to each receipt. In addition, the applicant submits that the amounts approved do not add up, and the applicant was not provided with sufficient information to determine how the expense was assessed by the respondent.

63The respondent did not make specific submissions on whether the EOB with respect to the OCF-6s were compliant with s. 38(8) of the Schedule.

64I find that s. 38(8) of the Schedule does not apply to the OCF-6s. This is because s. 38(1) provides that s. 38 applies to medical and rehabilitation benefits, other than those payable in accordance with the Minor Injury Guideline and all applications for approval of assessments or examinations. The section is entitled “Claim for Medical or Rehabilitation Benefits”. Further, sections 38(8) and 38(11) specifically reference a treatment and assessment plan. In this case, the applicant has not submitted a treatment and assessment plan. The OCF-6s are ‘Expenses Claim Forms’ and, in this case, they are used to claim expenses under section 22, as noted above. Therefore, the procedural aspects of s. 38 do not apply to these OCF-6s.

65I find that the respondent did provide reasons for the denial in EOBs and the reasons were understandable during my review. The respondent did reply to the OCF-6 submitted, clearly stated that the submitted expenses were not approved, and provided reasons why additional information is being requested. In the case of the OCF-6 for $13,237.84 for visitor travel and meal expenses (partially approved for $3,197.78 leaving $10,040.06 in dispute), there was a detailed breakdown of which receipts were denied and the reason for the denial.

66For the above-noted reasons, I find that the OCF-6s are not payable pursuant to s. 38(11) of the Schedule. Section 38(8) only applies to treatment and assessment plans.

Award

67I find the applicant is not entitled to an award for the following reasons.

68The applicant sought the maximum 50% special under s. 10 of Regulation 664. Under s. 10, the Tribunal may grant an award of up to 50 per cent of the total benefits payable plus interest if it finds that an insurer unreasonably withheld or delayed the payment of benefits.

69The applicant submits that the respondent’s actions were unreasonable at every stage as a result of:

i. Denying expenses that had previously been approved on identical evidence;

ii. Advancing a restrictive interpretation of section 22(1) without legal support;

iii. Labeling digital receipts “illegible” without review or particulars;

iv. Evidence of lack of diligence and analysis reviewing the receipts that were self explanatory and would have demonstrated the bulk of the addresses were not their home, but the paid accommodations and the particulars sought for the Uber rides;

v. Treating pre-packaged food as “groceries” despite clear necessity and cost-saving; and

vi. Failing to provide meaningful communication in response to repeated inquiries by applicant’s counsel.

70The respondent counters that the applicant is not entitled to an award under s.10 of Reg. 664. The respondent acknowledges that there were responses from the applicant’s counsel in relation to the OCF-6s, however, the responses were circular and did not provide the requested information. The respondent argues that there was no bad faith, simply requests for more information that were not addressed satisfactorily.

71I find that both parties share responsibility in the development of this dispute. The respondent did not provide clear direction on reimbursable costs and daily maximums for expenses associated with visitor expenses at the onset. This is standard practice in corporate entities where limits are established for each meal, mileage, and/or per diem and this information would have been helpful to provide clarity to the applicant’s family. The applicant’s family also did not exercise restraint in the expenses which were accumulated during this difficult time. Overall, I find that claiming $20,349.82 in visitor expenses in the span of three months to be excessive, particularly when considering that this covered only local transportation within the Greater Toronto Area and the meals were purchased primarily from fast food franchises.

72I agree that Uber Eats service and delivery fees increase the total amount of the meal significantly in comparison for meals which are consumed in a restaurant or picked up by the visitor, however, since clarification that coverage for this type of expense was not provided to the family at the onset of the claim, I decline to find that these fees are not payable once the expense has been submitted.

73I find that the applicant is not entitled to an award in this matter because I am not persuaded that the respondent’s actions rise to the level of excessive, imprudent, stubborn, inflexible, unyielding or immoderate behaviour. There was a large volume of receipts, overlap between reimbursement periods for the three OCF-6s submitted, and it was simply difficult to determine what was spent per month, by whom, and for what purpose.

74The applicant is not entitled to an award under s. 10 of Regulation 664.

Interest

75Interest is payable on any overdue amounts in accordance with s. 51 of the Schedule.

ORDER

76The applicant is entitled to $2,776.38 for Uber Eats and Uber transportation in relation to the OCF-6 for $3,503.74.

77Paragraph [42] above provides a list of reasonable and necessary expenses based on the address where the expense was incurred. I direct the parties to utilize the addresses provided to re-review meal and transportation receipts which have not already been approved to calculate the additional payment to which the applicant is entitled to in relation to the partially approved OCF-6 for $10,040.06 ($13,237.84 less $3,197.78 approved).

78The applicant is not entitled to an award under s. 10 of Regulation 664.

79Interest is payable on any overdue amounts in accordance with s. 51 of the Schedule.